Experts Share Otolaryngology Best Practices

SAN DIEGO—A review of the literature tells a story about septoplasty for nasal obstruction that differs from what many otolaryngologists might think: Very young patients can be considered for the procedure, well before facial growth is complete, an expert said here in January at the Triological Society Combined Sections Meeting.

The distillation of the data was one of several points experts made in a series of talks, which also covered topical agents for scarring, asymmetric sensorineural hearing loss and imaging, topical epinephrine and endoscopic sinus surgery, and peri-operative steroids in parotid surgery. The presentations often changed viewpoints among audience members, who participated in informal polling.

Pediatric Septoplasty

Sukgi Choi, MD,  from the Department of Otolaryngology and Communication Enhancement at Boston Children’s Hospital, said the evidence shows that pediatric septoplasty for nasal obstruction can be done safely, without a significant effect on nasal and facial growth, in very young children.

“In patients with functional problems due to nasal obstruction, early septoplasty represents a reasonable and supported treatment option for children as young as age six,” she said.

In a study of 25 boys and 19 girls, researchers assessed patients 12 years after septoplasty and compared them to normal controls on 11 measures of facial growth. The ages of the children who underwent septoplasty ranged from 5.6 to 12.5. Researchers found no significant differences on any measurements except reduced nasolabial angle in girls—and even then, only in extracorporeal procedures (Am J Rhinol Allergy. 2011;25:e7-12).

No investigation has demonstrated a positive correlation of corticosteroids on improved facial nerve function. —Maie St. John, MD, PhD

Other studies have found that adolescent growth can cause more alteration of nasal structures that are already deviated, and that septoplasty might even be acceptable in patients younger than six (Am J Rhinol Allergy. 2016;30:e42-47).

Post-Incision Scarring

In another talk, David Hom, MD, co-director of facial plastic and reconstructive surgery at the University of California, San Diego, said that research shows topical silicone gel, cyanoacrylates, and paper taping reduce post-incision scarring, while vitamin E and onion extract are not helpful.

A randomized controlled study (Clin Exp Dermatol. 2009;34:688-693) found that silicone gel applied twice a day for 60 days significantly reduced scarring and keloids—a more than 50% reduction—as compared with zinc oxide. The study included 65 people in the treatment group and 45 people in the control group, with wounds in different areas of the body. The findings are  Evidence Level 1, considered the most rigorous, as are findings from studies that produced similar results for cyanoacrylates and paper taping (Aesthetic Plast Surg. 2011;35:373-381). Randomized studies found onion gel and vitamin E are ineffective as compared with controls, when applied for six or eight weeks (J Plast Reconstr Aesthet Surg. 2011;64:e137-145).